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The Enigma Ellen West - McGill University - 15.12.10
The Enigma Ellen West - McGill University - 15.12.10
The Enigma “Ellen West”
The Enigma “Ellen West”Ludwig Binswanger’sfoundation case of existential analysis
The Enigma “Ellen West”Ludwig Binswanger’sfoundation case of existential analysis“A mirror of twentieth-centurypsychiatry”
Vincenzo Di NicolaDoctoral candidate EuropäischeUniversitätfürInterdisziplinäreStudien(European University for Interdisciplinary Studies)Saas-Fee, Wallis, Schweiz
Europe –Switzerland
Die Schweiz – Switzerland
Kanton Wallis – Canton du Valais
The Enigma Ellen West - McGill University - 15.12.10
The Enigma Ellen West - McGill University - 15.12.10
Les langues de la Confédération suisse
SwissPhilosophersJean-Jacques RousseauRichard AvenariusJean PiagetLudwig Binswanger
SwissScientistsParacelsusAlbert EinsteinWolfgang PauliPaul DiracAlbert Hofmann
Psychiatres, psychologues et psychanalystes suissesHenri EllenbergerJean PiagetBärbelInhelderElisabeth Kübler-RossAlice MillerCarlo StrengerAuguste ForelHermann RorschachCarl Gustav JungOskar PfisterEugen BleulerLudwig Binswanger
The Case “Ellen West”Ludwig Binswanger’sfoundation case of existential analysis
The Enigma Ellen West - McGill University - 15.12.10
“Ellen West” (1888-1921)
Ludwig Binswanger(1881-1966)
The Enigma Ellen West - McGill University - 15.12.10
The Enigma Ellen West - McGill University - 15.12.10
Der Fall Ellen Westby Ludwig Binswanger1944-45: Der Fall Ellen West. Schweizer Archivfür Neurologie und Psychologie, 1944, 53: 255-277, 54: 69-117; 1945, 55: 16-40.1957: Schizophrenie. Pfullingen: Neske.1958: The Case of Ellen West: An Anthropological-ClinicalStudy  (trans. by Werner M. Mendel & Joseph Lyons, pp. 237-364), in Existence: A New Dimension in Psychiatry and Psychology (ed. Rollo May, Ernest Angel & Henri F. Ellenberger). New York: Basic Books.
Der Fall Ellen West résumé en françaisStorch, Alfred (1958). « À propos de Schizophrénie de Ludwig Binswanger. » L’Évolution Psychiatrique, 3 : 577-602.Ellenberger, Henri F. (1974/2001). À la découverte de l'inconscient, Paris : SIMEP. Réédité sous le titre Histoire de l'inconscient, Paris : Fayard.Postel, Jacques (1993/2003). Dictionnaire de psychiatrie et de psychopathologie clinique. Paris : Larousse.
Ellen West: childhood, youthBorn in 1888 into a Jewishfamily, Ellen arrives in Europe at the age of 10As a child, she expresses hercharacterearly: 			stubborn, mischievous, disobedientAlso: a good student, lively, ambitious, sheappliesherselfintenselyintoeverythingsheundertakesIntelligent and sensitive, shetakes the matura and then passes the exams to become a teacherwhichallowsher to enter universityEllen reads a great deal – notably R.M. Rilke and J.W. von GoetheAfterthesereadings, shebecomes an atheist and adopts a rebellious attitude towards bourgeois life
Ellen West: attachmentsEllen falls in love numerous timesForbiddeneach time by her parents who oblige her to break up her engagementsAt the age of 28, withher parents’ permission at last, she marries a cousin
Ellen West: embodimentAround the age of 20 Ellen begins to beafraid to gain weightSheexperiencesstrongcravings for food, accompanied by the fear of getting fatAll of whichbringsher to feeldepressedEllen’s solution: taking laxatives to staythin, up to 60 packets a day
Ellen West: embodiment (ii)She has a miscarriagefollowing a vigoroushikeduringwhichshe has a haemorrhageShe suspends taking laxatives as shewants a babyHer intense desire to loseweightreturns: Ellen refuses to eatnormally and startstaking laxatives againHermenstrualperiodsdisappear, yetsheismotivated to staythinwhichattenuateshersadness/depressionAt the age of 30, shebecomes a vegetarian
Ellen West: psychiatriccareerAt31, after 3 years of marriage, nowamenorrheic, havingendedsexual relations for 2 years, Ellen decides to sharehersufferingwithherhusbandIn thisperiod, shemakes 8 suicidal“gestures”Ellen encountersmedicalspecialists, visits Sanatoria, beginspsychoanalysis and meets the psychiatricelite of the time: Eugen Bleuler, Emil Kraepelin and Ludwig Binswanger …The psychiatrists are not in agreement about the diagnosis
Ellen West: subjective experiencesEllen almostconstantlyexperiences a pervasivedreadwhichisat once generalized and connected to weight gainSheexhibits an obsession withthinness and a fear of gainingweightShefeels an “emptiness,” an “existential anxiety”
Ellen West:  subjective experiences (ii)Ellen lives a dichotomy: a split betweentheethereal world and thetomb-world(according to Binswanger)The spiritual versus the physicaltranslated/experienced by Ellen as the ideal of the soul (pure and empty) versus    the fear of herownembodiment (the heaviness/gravity of feeling full, pregnant, a bourgeoise)
Ellen West: explication philosophique« Tout le mouvement de son existence s’épuise dans la peur phobique d’une chute dans la tombe, et dans le désir délirant qui planerait dans l’éther et cueillerait sa jouissance dans l’immobilité du mouvement pur. Mais ce que désignent cette orientation et la polarité affective qu’elle implique, c’est la forme même selon laquelle se temporalise l’existence. L’avenir n’est pas assumé par la malade comme dévoilement de sa plénitude et anticipation de la mort. La mort, elle l’éprouve déjà là, inscrite dans ce corps qui vieillit et que chaque jour alourdit d’un poids nouveau ; la mort n’est pour elle que le pesanteur actuelle de la chair, elle ne fait qu’une seule et même chose avec la présence de son corps. » —Michel Foucault (1954). « Introduction ».  			Le rève et l’existence, L. Binswanger
Ellen West: philosophical explication« Tout le mouvement de son existence s’épuise dans la peur phobique d’une chute dans la tombe, et dans le désir délirant qui planerait dans l’éther et cueillerait sa jouissance dans l’immobilité du mouvement pur. Mais ce que désignent cette orientation et la polarité affective qu’elle implique, c’est la forme même selon laquelle se temporalise l’existence. L’avenir n’est pas assumé par la malade comme dévoilement de sa plénitude et anticipation de la mort. La mort, elle l’éprouve déjà là, inscrite dans ce corps qui vieillit et que chaque jour alourdit d’un poids nouveau ; la mort n’est pour elle que le pesanteur actuelle de la chair, elle ne fait qu’une seule et même chose avec la présence de son corps. » —Michel Foucault (1954). « Introduction ».  			Le rève et l’existence, L. Binswanger
Michel Foucault(1926-1984)
Ellen West: philosophicalexplication (ii)«  La mort, elle l’éprouve déjà là, inscrite dans ce corps qui vieillit et que chaque jour alourdit d’un poids nouveau ; la mort n’est pour elle que le pesanteur actuelle de la chair, elle ne fait qu’une seule et même chose avec la présence de son corps. » —Michel Foucault (1954)See: Simone Weil (1947), La Pesanteur et la grâce/Gravity and GraceWassheanorexic? Simone Weil isconsideredanorexic in the eatingdisorders and feministliterature
Simone Weil(1909-1943)
Ellen West: “enforcedseparations”Ellenexperienced a quite impressive list of “enforcedseparations” (RD Laing):Herfatherorderedher to break her first engagement.Her second engagement was“temporarilydiscontinued”at the instigation of herfather and mother.Her first analysisisterminated for “externalreasons.”Her second analystorderedherhusband to leaveher.A psychiatristorderedher to end her second analysis.
The Enigma Ellen West - McGill University - 15.12.10
“Ellen West”
“Ellen West”
Kreuzlingen – Canton du Thurgovie
Das Sanatorium Bellevue 1857-1980 - Kreuzlingen
Famous Patients ofThe Bellevue Sanatorium“Anna O” Bertha Pappenheim (1859-1936): July-October1882 Aby Warburg (1866-1929): 1921-24“Ellen West” (1888-1921): January-March1921
Anno O Bertha Pappenheim (1859-1936)
Anna O’sPhysiciansDr Josef BreuerDr Sigmund Freud
Aby Warburg(1866-1929)
The Constructions “ Ellen West”“A Mirror of Twentieth-CenturyPsychiatry”
The Enigma Ellen West - McGill University - 15.12.10
Edmund Husserl(1859-1938)
Martin Heidedgger(1889-1976)
Être et Temps/ Being and Time (1927) Emmanuel Lévinas :« Heidegger est pour moi le plus grand philosophe du siècle, peut-êtrel’un des trèsgrands du millénaire ; mais je suistrèspeiné de cela, parceque je ne peuxjamaisoubliercequ’ilétait en 1933, mêmes’il ne l’étaitque pendant unecourtepériode. Cequej’admiredans son œuvrec’estSein und Zeit. C’est un sommet de la phénoménologie. Les analyses sontgéniales …. Rassurez-vous : je ne suis pas ridicule, je ne sauraisméconnaître la grandeur spéculative de Heidegger. »
Emmanuel Lévinas(1906-1995)
Hannah Arendt(1906-1975)
Giorgio Agamben(Born 1943)
Emil Kraepelin(1856-1926)
Eugen Bleuler(1857-1939)
Viktor Emil von Gebsattel(1883-1976)TheodorLipps (Munich)
Max Scheler (Munich)
Wilhelm Dilthey (Berlin)
Emil Kraepelin (Munich)1stPsychoanalysis of Ellen West:February – August 1920
Hans von Hattingberg(1879-1944 )ViennaMunich2ndPsychoanalysis of Ellen West:1920 -  January 1921
R.D. Laing(1927–1989)
Jean-Paul Sartre(1905-1980)
Salvador Minuchin(Born 1921)
MaraSelviniPalazzoli(1916-1999)
Karl Jaspers(1883-1969)
FreudPsychotherapyPsychoanalysisBiology/clinicalpsychiatry“Body”BinswangerExistential analysisPhenomenology/clinicalpsychiatry“Existence”Bühler, Karl-Ernst (2004). Existential analysis and psychoanalysis: Specificdifferences and personalrelationshipbetween Ludwig Binswanger and Sigmund Freud. American Journal of Psychotherapy,58 (1): 34–50.
Existential PsychiatryEugène Minkowski (1885-1972)« Je donne une œuvre subjective ici, œuvre cependant qui tend de toutes ses forces vers l'objectivité. »I amoffering a subjective workhere, whichaimsneverthelesstowardobjectivitywith all its force. FoundedL’Évolution psychiatrique
Existential PsychiatryBinswangerRD LaingBinswanger’saccountis not about the person of Ellen but rather“of the existential Gestalt to whichwe have given the name of Ellen West” based on documents written by Ellen and her husbandHismethodis to lay out beforehim all of the life-history of Ellen in as muchdetail as possible, leaving out as far as possible all moral, aesthetic, social, medical or anykind of judgements, free of all pre-judgements.He will direct his gaze at the finishedform of her existence in the world, dissecting a deadbutterfly of hisfancy, not depicting the pathetic life of a defeatedperson.… exactly“becausehedid not know herpersonally” the “conditions wereparticularlyfavourable to an existential analysis”“No need to pass time in the presence of a personwhosepresence in the world issototallyunfortunate and miserable.“The existential Gestaltthatis Ellen Westisunable to ‘relate.’ Hisstudy exemplifies exactlywhatheattacks.”
Evolution of PsychiatryClinicalPsychiatry  – 					Mental illness+ biologyDynamicPsychiatry – 				Psychoanalysis + clinicalpsychiatryExistential Psychiatry – 				Psychoanalysis + phenomenology + clinicalpsychiatryCriticalPsychiatry – 				Psychiatry + or psychiatry –
Evolution of CriticalPsychiatrySystemsGregory BatesonRD LaingWhitaker/AndolfiMinuchinSelviniPalazzoliCultureFrantz FanonWittkower, Murphy, PrinceArthur KleinmanGeorges Devereux/Tobie Nathan
Evolution of CriticalPsychiatryFeminismMaraSelviniPalazzoliSusie OrbachKim CherninJulie KristevaLuce IrigaryPoliticsFrantz FanonGilles Deleuze/Félix GuattariFranco BasagliaRD Laing/David CooperThomas Szasz
Ellen West: interventionsInternalmedicinePsychiatrists – 	“psychoanalysts” Psychiatric consultationsHospitalizationInterventionsMedical care, managementvonGebsattel,                       vonHattingbergKraepelin, Hoche,           Bleuler, BinswangerBellevue SanatoriumClosed unit vs discharge,        assisted suicide,                existential analysispost hoc
Ellen West: diagnosesDuringhertreatmentReadings of the caseMelancholia(Kraepelin)Hysteria(vonGebsattel)Obsessionalneurosiswithmanic-depressive oscillations (vonHattingberg)Psychasthenia(Hoche)Schizophrenia Simplex (Bleuler, Binswanger)Anorexie hystérique (Charles Lasègue)Anoressia mentale (MaraSelviniPalazzoli)Folie hystérique (Jean- Claude Maleval)Anorectic(Salvador Minuchin)Bulimiawithobsessive-compulsivephenomenology, dysphoriaassociatedwith borderline personalitydisorder(NassirGhaemi)Anorexia, melancolia, neurosenarcísica 		(ManoelBerlinck& Ana CecíliaMagtaz)Insécurité ontologique, honte du corps    (Jean-Claude Marceau)
Ellen West: diagnosesDuringhertreatmentReadings of the caseMelancholia(Kraepelin)Hysteria(vonGebsattel)Obsessionalneurosiswithmanic-depressive oscillations (vonHattingberg)Psychasthenia(Hoche)Schizophrenia Simplex (Bleuler, Binswanger)Thesolepsychiatristwhoresisted to diagnosisher?R.D. Laing, The Voice of Experience (1982)He concentrateshis critique rather on Binswanger’smethodHisstudy of Ellen West contributed to distancinghimselffromtraditionalpsychiatry, from the diagnostic perspective and from the concept of simple schizophrenia
The Gestalt“Ellen West”PsychiatricphenomenologyExistentialRelationalSocioculturalPhobia/obsession/delusion?Emptiness, ontologicalinsecurityAll relationships/RxinterruptedA woman in a traditional/patriarchalfamily/societyA Jewish patient in an antisemiticsociety
Pierre Janet(1859-1947)
Janet’s Case of NadiaChapter:« L’obsession de la honte du corps »The obsession withbodilyshameYoung woman of 27 yearswhoadopted a bizarre eating pattern for fear of gainingweight (twosoups, an eggyolk, a spoon of vinager and a cup of strongteawithlemonjuice)Shealternatedbetweenbulimic crises and hours of rumination on food and eating as tortureDx:“anorexie hystérique” – hysterical anorexiaJanet, Pierre (1903). Les obsessions et la psychasthénie. Paris : Alcan.
“Ellen West”Binswangerdiscusses the question of embodiment in psychosisDressedexclusively in pants until the age of 16 yearsDeathis for herisjust the heaviness of herflesh, Ellen speaks of the ethereal world“Nadia”Cited by BinswangerSeeks to hidehersex/gender by dressing like a man; shewouldreallylike to bewithoutanysex, withoutany bodyBeyondbeingthin, Nadia wishes to no longer be in her body and speaks of the existence of an angel
TheSchizophreniasKraepelinDementia praecox oderGruppederSchizophrenien(1911)Dementia Praecox or The Group of SchizophreniasBleuler introduces the new termschizophrenias for dementiapraecoxKlinische Psychiatrie (1899)ClinialPsychiatryKraepelin proposes the dichotomybetweendementiapraecox etmanic-depressiveillnessBleuler
WhoKilled“Ellen West”?A Philosophical-Psychiatric Investigation
TheDeath of “Ellen West”I becamefascinated by the question of responsability.Whocausedherdeath, directly or indirectly?—Salvador Minuchin (1984)
Aftertwo suicide attempts by Ellen West, begins a series of consultations with the founders of modern psychiatry: Emil Kraepelin (1856-1926), architect of today’spsychiatricnosology, diagnoses melancholiafinds a simple psychasthenia. Alone in perceivingwhat the Gestalt revealsisBinswanger, confirmed by the authority of Eugen Bleuler (1857-1939)whonamed the emblematic condition of psychiatry: SchizophreniaSimplex(simple schizophrenia), a progressive schizophrenicpsychosis
Their opinions notwithstanding, Ellen’smelancholy and her suicide attemptspersist, accompanied by seriouseatingproblems. Convinced of the grave and incurable diagnosis, withouthope, all therapiesinterrupted, suspended or withdrawn, Binswangeraccedes to the patient’srequest: Ellen isdischargedfrom the Sanatorium.
After 3 dayswithherfamily, Ellen appearstransformed: she has breakfast, atnoonsheeatswell for the first time in 13 years, during the afternoonshegoes for a walkwithherhusband, readspoems and writesletters. All the heavinessisliftedfromherbeing. That night, shetakes poison.The nextday, at the age of 33 years, Ellen West isdead.
Binswangerreassures the reader not lessthan 17 times thather suicide is“authentic.”Laing concludes his reading with bitter irony: 		Poor little rich girl.
The Death of “Ellen West”Asuicide? - authentic?An assisted suicide?A psychic-ontological homicide?
The Deathof “Ellen West”« An authenticsuicide » according toBinswanger(1944-45)Binswanger, Ludwig (1944-45). « Der Fall Ellen West. » Schweizer Archivfür Neurologie und Psychologie, 1944, 53 : 255-277, 54 : 69-117; 1945, 55 : 16-40.
The Death of “Ellen West”« An assisted suicide » according toAkavia (2008)Akavia, Naamah (2008). « Writing “The Case of Ellen West” : ClinicalKnowledge and HistoricalRepresentation. » Science in Context, 21 : 119-144.
The Death of “Ellen West”« A psychic homicide » according toLester (1971)Lester, David (1971). « Ellen West’s suicide as a case of psychic homicide. » PsychoanalyticReview, 58 : 251-263.
The Death of “Ellen West”An assisted suicideThe authenticity of whichisprecisely question A psychic homicide in which suicide as a solution wasinducedfrom the outsideAn ontological annihilation by the family, herhusband et herphysicianssuppported by the psychiatrist Alfred Hoche and hisjustfication to “annihilate life unworthy of life”
The Death of “Ellen West”A psychic homicide, an ontological annihilationBinswangererrswith the diagnosis of schizophrenia, heconsults Alfred Hoche, a psychiatristknown for histextwith the jurist Karl Bindingjustifying suicide and euthanasie for “life unworthy of life”He takes away her hope for living and collaborates with her husband to induce her suicideAfter—more than 20 years later, he reconstructs The Case Ellen West to justify himself: he tries to convince us that his distance helps him to understand and insists 17 times in the text that the suicide was authentic
The Doctor-Patient RelationshipVon GebsattelLittleknown in the English or French literatureHe speaks to the doctor-patientrelationshipHe insists on the presence of the person in boththe patient and the doctor to resist the dehumanization of medicine (what Foucault will call desubjectivation)Welie, Jos VM (1995). Viktor Emil vonGebsattel on the Doctor-Patient Relationship. TheoreticalMedicine, 16: 41-72.
Alfred Erich Hoche(1865-1943)
Karl Binding(1841-1920)
« VernichtunglebensunwertenLebens »The Permission to Annihilate Life Unworthy of Life:Its Measure and Its FormBy Professors Karl Binding, JD, PhD et Alfred Hoche, MD(1920)
Medscape 2010 PhysicianEthics Survey“Palliative care is one thing, but suicide is not within the scope of acceptable physicianbehavior.”“I do not believe in assisted suicide, but I do believe in withdrawal of support. If the patient isterminallyill and suffering and thereisabsolutely no hope to survive, then I withdraw the support (eg, antibiotictreatment, bloodtesting, or transfusions).”“Assisted suicide ismurder.”
Medicine and the GermanJewsThere are verydeephistorical and socioculturaltiesbetweenGermans, Jews, and medicinesince the Middle AgesIn the evolution of Germanmedicine, a language of the degenerating body and the metaphor of regenerationwaselaborated and inscribedintotheories and practices, to whichJewishphysiciansthemselvesadhered and withwhichtheydescribedthemselvesThe Jewish body wasperceived as sick and diseased, the sign of a national disease due to theirpowerlessness as a people with a country (adopted by the earlyZionists)This perception—let’s call it an episteme or discoursefollowing Foucault—becomesdistorted and abused by the Nazis whospeakincessantly of racial purity and the degenerateJewsJohn M. Efron (2001). Medicine and the GermanJews: A History. 	New Haven : Yale UniversityPress.
Ellen West : victim of herself, of life, of assisted suicide?How could a sophisticated and brilliant man likeBinswanger,comingfrom a medical tradition of great distinction (practically noble) on severallevels—nationally (Switzerland), culturally (German) and in hisfamily, and havingJewishfriends, mentors and interlocutors (notably Freud) bringhimself to consult a man like Hoche as a consultant for a patient whowasJewish, suicidal and in despair due to the diagnosis of an incurable illness? Wenow know that Ellen West and herhusbandcontestedthischoice of consultant and did not findhim acceptable knowingverywellhisreputationbased on hisideas about euthanasia and assisted suicide, whichacceleratedherdepartturefrom Bellevue SanatoriumHoche’s and Binding’stextwillbecome the inspiration and justification for the final solution of the Jewish question, thatis to say, the extermination of the Jews of Europe, declared by the Nazis at the WannseeConferencenear Berlin in 1942
ReflectionsIn spite of the efforts of manygreatthinkers of the 20th century – fromKraepelin, BleulerandBinswanger to  SelviniPalazzoli, LaingandMinuchininpsychiatry and  Foucault en philosophy– « Ellen West »remains an enigma for us. Whatremainspossible for us is to undertake a philosophicalarchaeologyto create new constructions of this case in order to integrate the phenomenological, systemic, sociocultural and ethical dimensions of her life.
Reflections« Ellen West »is a mirror of 20th centurypsychiatry but the issues and the riskswefindthere are stillpresent and salientWhatis the central task of psychiatry: 				to comprehend, to classify or to cure?Is it possible to accomplishit (or them) objectively and atwhatprice?Whitherthensubjectivity?
ReflectionsIs contemporarypsychiatry more in the spirit of Kraepelin who inspires the thinkingbehind the DSM and evidence-basedmedicine or ratherthat of Bleuler, disciple of Freud, whoinspireddynamicpsychiatry?Is it the critical and humanistic spirit of Laing whoinspired the family and communitypsychiatrymovement in Britain and beyond or that of Minuchinwhodeclaredthatfamilytherapywouldtake over psychiatry in the US?
ReflectionsSo thatourhumanencounters in the clinical do not become or stayenigmatic (seevonGebsattel, Sartre, Foucault),we have the choice to practice our profession – thisimpossible profession according toFreud – in a waythatisalways more human and empathic.
Réflexions« On ne peut comprendre les troubles psychiques du dehors » mais par « un effort constant pour saisir la situation de base et pour la revivre », ce qui nous rapprochera au « temps où la psychiatrie sera, enfin, humaine.»       —Jean-Paul Sartre à l’avant-propos de Raison et violence (Laing et Cooper,  1964)
Reflections“One cannotunderstandpsychologicaldistubancesfrom the outside, on the basis of a positivisticdeterminism, or reconstructthemwith a combination of concepts thatremainoutside the illness as lived and experienced … without a constant effort to grasp the basic situation and to reliveit, without an attempt to rediscover the response of the person to that situation …whichwillbringcloser the daythatpsychiatrywill, at last, become a trulyhumanpsychiatry.”—Jean-Paul Sartre, Foreword, Reason and Violence (Laing & Cooper, 1964)
Alain Badiou(né 1937)Pour guérir quelle blessure, pour ôter quelle écharde dans la chair de l’existence suis-je devenu ce qu’on appelle un philosophe?                                              – Alain BadiouPréface, Après la finitude                          de Quentin Meillassoux                                      (Paris, Éditions du Seuil, 2006)
Alain Badiou“What wound was I seeking to heal, what thorn was I seeking to draw from the flesh of existence when I became what is called ‘a philosopher’?”“It may be that, as Bergson maintained, a philosopher only ever develops one idea. In any case, there is no doubt that the philosopher is born of a single question, the question which arises at the intersection of thought and life at a given moment in the philosopher's youth; the question which one must at all costs find a way to answer.” Preface, After Finitude, Quentin Meillassoux                                      (Continuum, 2008)
Ludwig Wittgenstein (1889-1951)The philosopher’streatment of a question islike the treatment of an illness.– §255 Ludwig Wittgenstein, Philosophical Investigations (1953)
BibliographyAgamben, Giorgio (2008). Signaturarerum. Sur la méthode (trad. de Joël Gayraud). Paris : Vrin. Akavia, Naamah (2008). « Writing “The Case of Ellen West” : ClinicalKnowledge and HistoricalRepresentation. » Science in Context, 21 : 119-144.  Basaglia, Franco (1965). « Corps, regard et silence. L’énigme de la subjectivité en psychiatrie. » L’Évolution Psychiatrique, 1 : 11-26.Berlinck, ManoelTosta & Magtaz, Ana Cecília (2008). « Reflexões sobre O caso de Ellen West : estudoanthropológico, de Binswanger. » RevistaLatinoamericana de PsicopatologiaFundamental, 11(2) : 232-238.
Binswanger, Ludwig (1944-45). « Der Fall Ellen West. » Schweizer Archivfür Neurologie und Psychologie, 1944, 53 : 255-277, 54 : 69-117; 1945, 55 : 16-40.Binswanger, Ludwig (1954/1955). Le Rêve et l’Existence, trad. de Jacqueline Verdeaux, introduction et notes de Michel Foucault. Paris, Desclée de Brouweret /Rééd. Aux Éditions de Minuit.Binswanger, Ludwig (1957). Schizophrenie. Pfullingen : Neske. Binswanger, Ludwig(1958). « The Case of Ellen West : An Anthropological-ClinicalStudy » (trad. de Werner M. Mendel & Joseph Lyons, p. 237-364), Existence : A New Dimension in Psychiatry and Psychology (éd. par Rollo May, Ernest Angel & Henri F. Ellenberger). New York : Basic.

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The Enigma Ellen West - McGill University - 15.12.10

  • 4. The Enigma “Ellen West”Ludwig Binswanger’sfoundation case of existential analysis
  • 5. The Enigma “Ellen West”Ludwig Binswanger’sfoundation case of existential analysis“A mirror of twentieth-centurypsychiatry”
  • 6. Vincenzo Di NicolaDoctoral candidate EuropäischeUniversitätfürInterdisziplinäreStudien(European University for Interdisciplinary Studies)Saas-Fee, Wallis, Schweiz
  • 8. Die Schweiz – Switzerland
  • 9. Kanton Wallis – Canton du Valais
  • 12. Les langues de la Confédération suisse
  • 15. Psychiatres, psychologues et psychanalystes suissesHenri EllenbergerJean PiagetBärbelInhelderElisabeth Kübler-RossAlice MillerCarlo StrengerAuguste ForelHermann RorschachCarl Gustav JungOskar PfisterEugen BleulerLudwig Binswanger
  • 16. The Case “Ellen West”Ludwig Binswanger’sfoundation case of existential analysis
  • 22. Der Fall Ellen Westby Ludwig Binswanger1944-45: Der Fall Ellen West. Schweizer Archivfür Neurologie und Psychologie, 1944, 53: 255-277, 54: 69-117; 1945, 55: 16-40.1957: Schizophrenie. Pfullingen: Neske.1958: The Case of Ellen West: An Anthropological-ClinicalStudy  (trans. by Werner M. Mendel & Joseph Lyons, pp. 237-364), in Existence: A New Dimension in Psychiatry and Psychology (ed. Rollo May, Ernest Angel & Henri F. Ellenberger). New York: Basic Books.
  • 23. Der Fall Ellen West résumé en françaisStorch, Alfred (1958). « À propos de Schizophrénie de Ludwig Binswanger. » L’Évolution Psychiatrique, 3 : 577-602.Ellenberger, Henri F. (1974/2001). À la découverte de l'inconscient, Paris : SIMEP. Réédité sous le titre Histoire de l'inconscient, Paris : Fayard.Postel, Jacques (1993/2003). Dictionnaire de psychiatrie et de psychopathologie clinique. Paris : Larousse.
  • 24. Ellen West: childhood, youthBorn in 1888 into a Jewishfamily, Ellen arrives in Europe at the age of 10As a child, she expresses hercharacterearly: stubborn, mischievous, disobedientAlso: a good student, lively, ambitious, sheappliesherselfintenselyintoeverythingsheundertakesIntelligent and sensitive, shetakes the matura and then passes the exams to become a teacherwhichallowsher to enter universityEllen reads a great deal – notably R.M. Rilke and J.W. von GoetheAfterthesereadings, shebecomes an atheist and adopts a rebellious attitude towards bourgeois life
  • 25. Ellen West: attachmentsEllen falls in love numerous timesForbiddeneach time by her parents who oblige her to break up her engagementsAt the age of 28, withher parents’ permission at last, she marries a cousin
  • 26. Ellen West: embodimentAround the age of 20 Ellen begins to beafraid to gain weightSheexperiencesstrongcravings for food, accompanied by the fear of getting fatAll of whichbringsher to feeldepressedEllen’s solution: taking laxatives to staythin, up to 60 packets a day
  • 27. Ellen West: embodiment (ii)She has a miscarriagefollowing a vigoroushikeduringwhichshe has a haemorrhageShe suspends taking laxatives as shewants a babyHer intense desire to loseweightreturns: Ellen refuses to eatnormally and startstaking laxatives againHermenstrualperiodsdisappear, yetsheismotivated to staythinwhichattenuateshersadness/depressionAt the age of 30, shebecomes a vegetarian
  • 28. Ellen West: psychiatriccareerAt31, after 3 years of marriage, nowamenorrheic, havingendedsexual relations for 2 years, Ellen decides to sharehersufferingwithherhusbandIn thisperiod, shemakes 8 suicidal“gestures”Ellen encountersmedicalspecialists, visits Sanatoria, beginspsychoanalysis and meets the psychiatricelite of the time: Eugen Bleuler, Emil Kraepelin and Ludwig Binswanger …The psychiatrists are not in agreement about the diagnosis
  • 29. Ellen West: subjective experiencesEllen almostconstantlyexperiences a pervasivedreadwhichisat once generalized and connected to weight gainSheexhibits an obsession withthinness and a fear of gainingweightShefeels an “emptiness,” an “existential anxiety”
  • 30. Ellen West: subjective experiences (ii)Ellen lives a dichotomy: a split betweentheethereal world and thetomb-world(according to Binswanger)The spiritual versus the physicaltranslated/experienced by Ellen as the ideal of the soul (pure and empty) versus the fear of herownembodiment (the heaviness/gravity of feeling full, pregnant, a bourgeoise)
  • 31. Ellen West: explication philosophique« Tout le mouvement de son existence s’épuise dans la peur phobique d’une chute dans la tombe, et dans le désir délirant qui planerait dans l’éther et cueillerait sa jouissance dans l’immobilité du mouvement pur. Mais ce que désignent cette orientation et la polarité affective qu’elle implique, c’est la forme même selon laquelle se temporalise l’existence. L’avenir n’est pas assumé par la malade comme dévoilement de sa plénitude et anticipation de la mort. La mort, elle l’éprouve déjà là, inscrite dans ce corps qui vieillit et que chaque jour alourdit d’un poids nouveau ; la mort n’est pour elle que le pesanteur actuelle de la chair, elle ne fait qu’une seule et même chose avec la présence de son corps. » —Michel Foucault (1954). « Introduction ». Le rève et l’existence, L. Binswanger
  • 32. Ellen West: philosophical explication« Tout le mouvement de son existence s’épuise dans la peur phobique d’une chute dans la tombe, et dans le désir délirant qui planerait dans l’éther et cueillerait sa jouissance dans l’immobilité du mouvement pur. Mais ce que désignent cette orientation et la polarité affective qu’elle implique, c’est la forme même selon laquelle se temporalise l’existence. L’avenir n’est pas assumé par la malade comme dévoilement de sa plénitude et anticipation de la mort. La mort, elle l’éprouve déjà là, inscrite dans ce corps qui vieillit et que chaque jour alourdit d’un poids nouveau ; la mort n’est pour elle que le pesanteur actuelle de la chair, elle ne fait qu’une seule et même chose avec la présence de son corps. » —Michel Foucault (1954). « Introduction ». Le rève et l’existence, L. Binswanger
  • 34. Ellen West: philosophicalexplication (ii)«  La mort, elle l’éprouve déjà là, inscrite dans ce corps qui vieillit et que chaque jour alourdit d’un poids nouveau ; la mort n’est pour elle que le pesanteur actuelle de la chair, elle ne fait qu’une seule et même chose avec la présence de son corps. » —Michel Foucault (1954)See: Simone Weil (1947), La Pesanteur et la grâce/Gravity and GraceWassheanorexic? Simone Weil isconsideredanorexic in the eatingdisorders and feministliterature
  • 36. Ellen West: “enforcedseparations”Ellenexperienced a quite impressive list of “enforcedseparations” (RD Laing):Herfatherorderedher to break her first engagement.Her second engagement was“temporarilydiscontinued”at the instigation of herfather and mother.Her first analysisisterminated for “externalreasons.”Her second analystorderedherhusband to leaveher.A psychiatristorderedher to end her second analysis.
  • 40. Kreuzlingen – Canton du Thurgovie
  • 41. Das Sanatorium Bellevue 1857-1980 - Kreuzlingen
  • 42. Famous Patients ofThe Bellevue Sanatorium“Anna O” Bertha Pappenheim (1859-1936): July-October1882 Aby Warburg (1866-1929): 1921-24“Ellen West” (1888-1921): January-March1921
  • 43. Anno O Bertha Pappenheim (1859-1936)
  • 44. Anna O’sPhysiciansDr Josef BreuerDr Sigmund Freud
  • 46. The Constructions “ Ellen West”“A Mirror of Twentieth-CenturyPsychiatry”
  • 50. Être et Temps/ Being and Time (1927) Emmanuel Lévinas :« Heidegger est pour moi le plus grand philosophe du siècle, peut-êtrel’un des trèsgrands du millénaire ; mais je suistrèspeiné de cela, parceque je ne peuxjamaisoubliercequ’ilétait en 1933, mêmes’il ne l’étaitque pendant unecourtepériode. Cequej’admiredans son œuvrec’estSein und Zeit. C’est un sommet de la phénoménologie. Les analyses sontgéniales …. Rassurez-vous : je ne suis pas ridicule, je ne sauraisméconnaître la grandeur spéculative de Heidegger. »
  • 56. Viktor Emil von Gebsattel(1883-1976)TheodorLipps (Munich)
  • 59. Emil Kraepelin (Munich)1stPsychoanalysis of Ellen West:February – August 1920
  • 60. Hans von Hattingberg(1879-1944 )ViennaMunich2ndPsychoanalysis of Ellen West:1920 - January 1921
  • 66. FreudPsychotherapyPsychoanalysisBiology/clinicalpsychiatry“Body”BinswangerExistential analysisPhenomenology/clinicalpsychiatry“Existence”Bühler, Karl-Ernst (2004). Existential analysis and psychoanalysis: Specificdifferences and personalrelationshipbetween Ludwig Binswanger and Sigmund Freud. American Journal of Psychotherapy,58 (1): 34–50.
  • 67. Existential PsychiatryEugène Minkowski (1885-1972)« Je donne une œuvre subjective ici, œuvre cependant qui tend de toutes ses forces vers l'objectivité. »I amoffering a subjective workhere, whichaimsneverthelesstowardobjectivitywith all its force. FoundedL’Évolution psychiatrique
  • 68. Existential PsychiatryBinswangerRD LaingBinswanger’saccountis not about the person of Ellen but rather“of the existential Gestalt to whichwe have given the name of Ellen West” based on documents written by Ellen and her husbandHismethodis to lay out beforehim all of the life-history of Ellen in as muchdetail as possible, leaving out as far as possible all moral, aesthetic, social, medical or anykind of judgements, free of all pre-judgements.He will direct his gaze at the finishedform of her existence in the world, dissecting a deadbutterfly of hisfancy, not depicting the pathetic life of a defeatedperson.… exactly“becausehedid not know herpersonally” the “conditions wereparticularlyfavourable to an existential analysis”“No need to pass time in the presence of a personwhosepresence in the world issototallyunfortunate and miserable.“The existential Gestaltthatis Ellen Westisunable to ‘relate.’ Hisstudy exemplifies exactlywhatheattacks.”
  • 69. Evolution of PsychiatryClinicalPsychiatry – Mental illness+ biologyDynamicPsychiatry – Psychoanalysis + clinicalpsychiatryExistential Psychiatry – Psychoanalysis + phenomenology + clinicalpsychiatryCriticalPsychiatry – Psychiatry + or psychiatry –
  • 70. Evolution of CriticalPsychiatrySystemsGregory BatesonRD LaingWhitaker/AndolfiMinuchinSelviniPalazzoliCultureFrantz FanonWittkower, Murphy, PrinceArthur KleinmanGeorges Devereux/Tobie Nathan
  • 71. Evolution of CriticalPsychiatryFeminismMaraSelviniPalazzoliSusie OrbachKim CherninJulie KristevaLuce IrigaryPoliticsFrantz FanonGilles Deleuze/Félix GuattariFranco BasagliaRD Laing/David CooperThomas Szasz
  • 72. Ellen West: interventionsInternalmedicinePsychiatrists – “psychoanalysts” Psychiatric consultationsHospitalizationInterventionsMedical care, managementvonGebsattel, vonHattingbergKraepelin, Hoche, Bleuler, BinswangerBellevue SanatoriumClosed unit vs discharge, assisted suicide, existential analysispost hoc
  • 73. Ellen West: diagnosesDuringhertreatmentReadings of the caseMelancholia(Kraepelin)Hysteria(vonGebsattel)Obsessionalneurosiswithmanic-depressive oscillations (vonHattingberg)Psychasthenia(Hoche)Schizophrenia Simplex (Bleuler, Binswanger)Anorexie hystérique (Charles Lasègue)Anoressia mentale (MaraSelviniPalazzoli)Folie hystérique (Jean- Claude Maleval)Anorectic(Salvador Minuchin)Bulimiawithobsessive-compulsivephenomenology, dysphoriaassociatedwith borderline personalitydisorder(NassirGhaemi)Anorexia, melancolia, neurosenarcísica (ManoelBerlinck& Ana CecíliaMagtaz)Insécurité ontologique, honte du corps (Jean-Claude Marceau)
  • 74. Ellen West: diagnosesDuringhertreatmentReadings of the caseMelancholia(Kraepelin)Hysteria(vonGebsattel)Obsessionalneurosiswithmanic-depressive oscillations (vonHattingberg)Psychasthenia(Hoche)Schizophrenia Simplex (Bleuler, Binswanger)Thesolepsychiatristwhoresisted to diagnosisher?R.D. Laing, The Voice of Experience (1982)He concentrateshis critique rather on Binswanger’smethodHisstudy of Ellen West contributed to distancinghimselffromtraditionalpsychiatry, from the diagnostic perspective and from the concept of simple schizophrenia
  • 75. The Gestalt“Ellen West”PsychiatricphenomenologyExistentialRelationalSocioculturalPhobia/obsession/delusion?Emptiness, ontologicalinsecurityAll relationships/RxinterruptedA woman in a traditional/patriarchalfamily/societyA Jewish patient in an antisemiticsociety
  • 77. Janet’s Case of NadiaChapter:« L’obsession de la honte du corps »The obsession withbodilyshameYoung woman of 27 yearswhoadopted a bizarre eating pattern for fear of gainingweight (twosoups, an eggyolk, a spoon of vinager and a cup of strongteawithlemonjuice)Shealternatedbetweenbulimic crises and hours of rumination on food and eating as tortureDx:“anorexie hystérique” – hysterical anorexiaJanet, Pierre (1903). Les obsessions et la psychasthénie. Paris : Alcan.
  • 78. “Ellen West”Binswangerdiscusses the question of embodiment in psychosisDressedexclusively in pants until the age of 16 yearsDeathis for herisjust the heaviness of herflesh, Ellen speaks of the ethereal world“Nadia”Cited by BinswangerSeeks to hidehersex/gender by dressing like a man; shewouldreallylike to bewithoutanysex, withoutany bodyBeyondbeingthin, Nadia wishes to no longer be in her body and speaks of the existence of an angel
  • 79. TheSchizophreniasKraepelinDementia praecox oderGruppederSchizophrenien(1911)Dementia Praecox or The Group of SchizophreniasBleuler introduces the new termschizophrenias for dementiapraecoxKlinische Psychiatrie (1899)ClinialPsychiatryKraepelin proposes the dichotomybetweendementiapraecox etmanic-depressiveillnessBleuler
  • 81. TheDeath of “Ellen West”I becamefascinated by the question of responsability.Whocausedherdeath, directly or indirectly?—Salvador Minuchin (1984)
  • 82. Aftertwo suicide attempts by Ellen West, begins a series of consultations with the founders of modern psychiatry: Emil Kraepelin (1856-1926), architect of today’spsychiatricnosology, diagnoses melancholiafinds a simple psychasthenia. Alone in perceivingwhat the Gestalt revealsisBinswanger, confirmed by the authority of Eugen Bleuler (1857-1939)whonamed the emblematic condition of psychiatry: SchizophreniaSimplex(simple schizophrenia), a progressive schizophrenicpsychosis
  • 83. Their opinions notwithstanding, Ellen’smelancholy and her suicide attemptspersist, accompanied by seriouseatingproblems. Convinced of the grave and incurable diagnosis, withouthope, all therapiesinterrupted, suspended or withdrawn, Binswangeraccedes to the patient’srequest: Ellen isdischargedfrom the Sanatorium.
  • 84. After 3 dayswithherfamily, Ellen appearstransformed: she has breakfast, atnoonsheeatswell for the first time in 13 years, during the afternoonshegoes for a walkwithherhusband, readspoems and writesletters. All the heavinessisliftedfromherbeing. That night, shetakes poison.The nextday, at the age of 33 years, Ellen West isdead.
  • 85. Binswangerreassures the reader not lessthan 17 times thather suicide is“authentic.”Laing concludes his reading with bitter irony: Poor little rich girl.
  • 86. The Death of “Ellen West”Asuicide? - authentic?An assisted suicide?A psychic-ontological homicide?
  • 87. The Deathof “Ellen West”« An authenticsuicide » according toBinswanger(1944-45)Binswanger, Ludwig (1944-45). « Der Fall Ellen West. » Schweizer Archivfür Neurologie und Psychologie, 1944, 53 : 255-277, 54 : 69-117; 1945, 55 : 16-40.
  • 88. The Death of “Ellen West”« An assisted suicide » according toAkavia (2008)Akavia, Naamah (2008). « Writing “The Case of Ellen West” : ClinicalKnowledge and HistoricalRepresentation. » Science in Context, 21 : 119-144.
  • 89. The Death of “Ellen West”« A psychic homicide » according toLester (1971)Lester, David (1971). « Ellen West’s suicide as a case of psychic homicide. » PsychoanalyticReview, 58 : 251-263.
  • 90. The Death of “Ellen West”An assisted suicideThe authenticity of whichisprecisely question A psychic homicide in which suicide as a solution wasinducedfrom the outsideAn ontological annihilation by the family, herhusband et herphysicianssuppported by the psychiatrist Alfred Hoche and hisjustfication to “annihilate life unworthy of life”
  • 91. The Death of “Ellen West”A psychic homicide, an ontological annihilationBinswangererrswith the diagnosis of schizophrenia, heconsults Alfred Hoche, a psychiatristknown for histextwith the jurist Karl Bindingjustifying suicide and euthanasie for “life unworthy of life”He takes away her hope for living and collaborates with her husband to induce her suicideAfter—more than 20 years later, he reconstructs The Case Ellen West to justify himself: he tries to convince us that his distance helps him to understand and insists 17 times in the text that the suicide was authentic
  • 92. The Doctor-Patient RelationshipVon GebsattelLittleknown in the English or French literatureHe speaks to the doctor-patientrelationshipHe insists on the presence of the person in boththe patient and the doctor to resist the dehumanization of medicine (what Foucault will call desubjectivation)Welie, Jos VM (1995). Viktor Emil vonGebsattel on the Doctor-Patient Relationship. TheoreticalMedicine, 16: 41-72.
  • 95. « VernichtunglebensunwertenLebens »The Permission to Annihilate Life Unworthy of Life:Its Measure and Its FormBy Professors Karl Binding, JD, PhD et Alfred Hoche, MD(1920)
  • 96. Medscape 2010 PhysicianEthics Survey“Palliative care is one thing, but suicide is not within the scope of acceptable physicianbehavior.”“I do not believe in assisted suicide, but I do believe in withdrawal of support. If the patient isterminallyill and suffering and thereisabsolutely no hope to survive, then I withdraw the support (eg, antibiotictreatment, bloodtesting, or transfusions).”“Assisted suicide ismurder.”
  • 97. Medicine and the GermanJewsThere are verydeephistorical and socioculturaltiesbetweenGermans, Jews, and medicinesince the Middle AgesIn the evolution of Germanmedicine, a language of the degenerating body and the metaphor of regenerationwaselaborated and inscribedintotheories and practices, to whichJewishphysiciansthemselvesadhered and withwhichtheydescribedthemselvesThe Jewish body wasperceived as sick and diseased, the sign of a national disease due to theirpowerlessness as a people with a country (adopted by the earlyZionists)This perception—let’s call it an episteme or discoursefollowing Foucault—becomesdistorted and abused by the Nazis whospeakincessantly of racial purity and the degenerateJewsJohn M. Efron (2001). Medicine and the GermanJews: A History. New Haven : Yale UniversityPress.
  • 98. Ellen West : victim of herself, of life, of assisted suicide?How could a sophisticated and brilliant man likeBinswanger,comingfrom a medical tradition of great distinction (practically noble) on severallevels—nationally (Switzerland), culturally (German) and in hisfamily, and havingJewishfriends, mentors and interlocutors (notably Freud) bringhimself to consult a man like Hoche as a consultant for a patient whowasJewish, suicidal and in despair due to the diagnosis of an incurable illness? Wenow know that Ellen West and herhusbandcontestedthischoice of consultant and did not findhim acceptable knowingverywellhisreputationbased on hisideas about euthanasia and assisted suicide, whichacceleratedherdepartturefrom Bellevue SanatoriumHoche’s and Binding’stextwillbecome the inspiration and justification for the final solution of the Jewish question, thatis to say, the extermination of the Jews of Europe, declared by the Nazis at the WannseeConferencenear Berlin in 1942
  • 99. ReflectionsIn spite of the efforts of manygreatthinkers of the 20th century – fromKraepelin, BleulerandBinswanger to SelviniPalazzoli, LaingandMinuchininpsychiatry and Foucault en philosophy– « Ellen West »remains an enigma for us. Whatremainspossible for us is to undertake a philosophicalarchaeologyto create new constructions of this case in order to integrate the phenomenological, systemic, sociocultural and ethical dimensions of her life.
  • 100. Reflections« Ellen West »is a mirror of 20th centurypsychiatry but the issues and the riskswefindthere are stillpresent and salientWhatis the central task of psychiatry: to comprehend, to classify or to cure?Is it possible to accomplishit (or them) objectively and atwhatprice?Whitherthensubjectivity?
  • 101. ReflectionsIs contemporarypsychiatry more in the spirit of Kraepelin who inspires the thinkingbehind the DSM and evidence-basedmedicine or ratherthat of Bleuler, disciple of Freud, whoinspireddynamicpsychiatry?Is it the critical and humanistic spirit of Laing whoinspired the family and communitypsychiatrymovement in Britain and beyond or that of Minuchinwhodeclaredthatfamilytherapywouldtake over psychiatry in the US?
  • 102. ReflectionsSo thatourhumanencounters in the clinical do not become or stayenigmatic (seevonGebsattel, Sartre, Foucault),we have the choice to practice our profession – thisimpossible profession according toFreud – in a waythatisalways more human and empathic.
  • 103. Réflexions« On ne peut comprendre les troubles psychiques du dehors » mais par « un effort constant pour saisir la situation de base et pour la revivre », ce qui nous rapprochera au « temps où la psychiatrie sera, enfin, humaine.» —Jean-Paul Sartre à l’avant-propos de Raison et violence (Laing et Cooper, 1964)
  • 104. Reflections“One cannotunderstandpsychologicaldistubancesfrom the outside, on the basis of a positivisticdeterminism, or reconstructthemwith a combination of concepts thatremainoutside the illness as lived and experienced … without a constant effort to grasp the basic situation and to reliveit, without an attempt to rediscover the response of the person to that situation …whichwillbringcloser the daythatpsychiatrywill, at last, become a trulyhumanpsychiatry.”—Jean-Paul Sartre, Foreword, Reason and Violence (Laing & Cooper, 1964)
  • 105. Alain Badiou(né 1937)Pour guérir quelle blessure, pour ôter quelle écharde dans la chair de l’existence suis-je devenu ce qu’on appelle un philosophe? – Alain BadiouPréface, Après la finitude de Quentin Meillassoux (Paris, Éditions du Seuil, 2006)
  • 106. Alain Badiou“What wound was I seeking to heal, what thorn was I seeking to draw from the flesh of existence when I became what is called ‘a philosopher’?”“It may be that, as Bergson maintained, a philosopher only ever develops one idea. In any case, there is no doubt that the philosopher is born of a single question, the question which arises at the intersection of thought and life at a given moment in the philosopher's youth; the question which one must at all costs find a way to answer.” Preface, After Finitude, Quentin Meillassoux (Continuum, 2008)
  • 107. Ludwig Wittgenstein (1889-1951)The philosopher’streatment of a question islike the treatment of an illness.– §255 Ludwig Wittgenstein, Philosophical Investigations (1953)
  • 108. BibliographyAgamben, Giorgio (2008). Signaturarerum. Sur la méthode (trad. de Joël Gayraud). Paris : Vrin. Akavia, Naamah (2008). « Writing “The Case of Ellen West” : ClinicalKnowledge and HistoricalRepresentation. » Science in Context, 21 : 119-144.  Basaglia, Franco (1965). « Corps, regard et silence. L’énigme de la subjectivité en psychiatrie. » L’Évolution Psychiatrique, 1 : 11-26.Berlinck, ManoelTosta & Magtaz, Ana Cecília (2008). « Reflexões sobre O caso de Ellen West : estudoanthropológico, de Binswanger. » RevistaLatinoamericana de PsicopatologiaFundamental, 11(2) : 232-238.
  • 109. Binswanger, Ludwig (1944-45). « Der Fall Ellen West. » Schweizer Archivfür Neurologie und Psychologie, 1944, 53 : 255-277, 54 : 69-117; 1945, 55 : 16-40.Binswanger, Ludwig (1954/1955). Le Rêve et l’Existence, trad. de Jacqueline Verdeaux, introduction et notes de Michel Foucault. Paris, Desclée de Brouweret /Rééd. Aux Éditions de Minuit.Binswanger, Ludwig (1957). Schizophrenie. Pfullingen : Neske. Binswanger, Ludwig(1958). « The Case of Ellen West : An Anthropological-ClinicalStudy » (trad. de Werner M. Mendel & Joseph Lyons, p. 237-364), Existence : A New Dimension in Psychiatry and Psychology (éd. par Rollo May, Ernest Angel & Henri F. Ellenberger). New York : Basic.
  • 110. Foucault, Michel (1954). « Introduction et notes. » Le Rêve et l’Existence par Ludwig Binswanger (trad. de Jacqueline Verdeaux). Paris : Desclée de Brouweret.Ghaemi, S. Nassir (2001). « Rediscovering existential psychotherapy : The contribution of Ludwig Binswanger. »American Journal of Psychotherapy55 (1) : 51–64.Laing, Ronald (1986). La Voix de l’expérience. Paris : Éditions du Seuil. Laing, Ronald D. et Cooper, David G. (1976). Raison et violence (avant-propos de Jean-Paul Sartre). Paris : Petite BibliothèquePayot.
  • 111. Lester, David (1971). « Ellen West’s suicide as a case of psychic homicide. » PsychoanalyticReview, 58 : 251-263.Marceau, Jean-Claude (2002). « La question de la corporéité dans le cas Ellen West de L. Binswanger. » L’Évolution Psychiatrique, 67(2) : 367-378.Minuchin, Salvador (1984). « The Triumph of Ellen West : An Ecological Perspective » (pp. 195-246), Kaleidoscope : Images of Violence and Healing. Cambridge, MA : Harvard UniversityPress.SelviniPalazzoli, Mara (1982). L’anoressia mentale : Dalla terapiaindividuale alla terapiafamiliare.Nuovaedizioneinteramentariveduta. Milano : Feltrinelli Editore.